NEW CLIENT EXTENSION FORM

1

Full Name* This field is required.

First Name

Last Name

2

Contact Number* This field is required.

Please enter a valid phone number.

3

Email Address* This field is required.

example@example.com

4

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

5

Have you ever had your hair colored before?* This field is required.

Yes

No

6

If so, please include any coloring that has occurred in the past 2 years, both at home and in the salon. As well as any treatments that you may have received. Be detailed!

8

Upload a photo of your hair. (Front view & Back)* This field is required.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

9

Upload hair Inspo photos* This field is required.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

10

What are you looking for in a new color?* This field is required.

Example: Brightness, face framing color, darker, etc.

11

How did you hear about Bleached Behavior Salon?* This field is required.

Instagram, Referral, ect.